Week 1 - lecture pt 1A, 1B Flashcards
daily urine volume and required water intake qh?
~1500-2500 mL, requires ~150-250 mL water intake qh
ddx of GU cause of fever?
acute PN
malignancy
acute prostatitis
epididymitis
ddx of GU complains with no fever?
simple cystitis, chronic PN
ddx of GU complaints with weight loss?
advanced cancer
renal insufficiency dt obstruction or infection
ddx of failure to thrive in children (GU causes)?
chronic obstruction, UTI, both, etc.
area/pattern of pain: localized to ipsilateral CVA
refers to umbilicus, testicle, labium
KD
pain is constant vs pain comes and goes
constant: KD origin, infectious
comes and goes: KD origin, obstructive
distention vs spasm pain?
distention will cause a dull ache
spasms present more as colic
both usu pain is coming from ureters
DDX of pain from bladder: burning pain w/voiding felt in suprapubic area? painful suprapubic area? little or no pain?
burning pain w/voiding in suprapubic area = acute cystitis
painful suprapubic area = acute urinary retention
little or no pain = chronic retention
vague discomfort, fullness in perineal, rectal or lumbrosacral area?
prostate (BPH)
pain in flaccid penis dt? pain in erect penis dt?
flaccid: inflammation dt STI, paraphimosis
erect: Peyronie’s dz, priapsim
testicular pain relieved with elevating the testicle?
epididymitis
torsion pain will NOT BE relieved with elevation of the testicle
renal pain caused by what? causes?
sudden distention of the renal capsule
causes: acute PN, acute ureteral obstruction
radicular pain caused by what?
poor posture, arthritic changes to local jts, impingement of subcostal nerve, intervertebral disc pressure, herpes zoster
ssxs of irritative micturation?
urgency, frequency, dysuria, nocturia
ssxs of obstructive micturation?
hesitancy, decreased force of stream, dribbling
20-40 M/F, pain throughout micturation, burning pain, no referral, no fever, polyuria, urethral d/c, inflamed urethra, no suprapubic pain w/palpation, (=) CVA tenderness, UA shows pyuria, bacteriuria and hematuria?
urethritis
F 15+ yrs, M: infant and elderly, pain midstream and late, burning pain, no referral pain or may cause dull abd or perineal pn, no fever, polyuria, gross hematuria, fatigue, suprapubic pn w/palpation, mildly (+) CVA, pyruia, bacteriuria, hematuria on UA
cystitis
F 15+ yrs, M: infant and elderly, variable timing of pn, mb burning pain, flank and abd pn, fever usu present and usu high, polyuria, myalgia, fatigue, weakness, N/V, painless suprapubic palpation unless concomitant dz process, CVA strongly (+), pyuria, bacteriuria, hematuria on UA
pyelonephritis
M 30+ yrs, variable timing of pn w/micturation, dull pelvic pn, pain referred to testes, general pelvic region, no fever, polyuria, altered libido, pn w/ejaculation, painless suprapubic palpation, mildly (+/=) CVA, pyuria or negative UA
chronic prostatitis
volumes related to bladder outlet obstruction?
20-25 ml/s in M, 25-30 mL/s in F = normal
<15 mL/s = suspect obstruction
<10 mL/s = definitive evidence of obstruction
if hesitancy, loss of force of stream, terminal dribbling suspect what?
BPH, urethral stricture
if urinary retention suspect what? what two forms are there?
acute: sudden inability to urinate, agonizing suprapubic pn w/urgency
chronic: hesitancy, reduced force, little discomfort, dribblign
if interruption of stream suspect what?
bladder stone, pain may radiate to urethra
if sense of residual urine could be what?
recurrent cystitis
if experiencing incontinence assume what anatomical abn?
sphincter abn
oliguria vs anuria?
oliguria <500 mL urine/d
anuria <100 mL urine/d
definition of microscopic hematuria?
excretion of >3 RBC/hpf
can come from anywhere along the tract
asx microscopic hematuria usu from where? gross hematuria usu from where?
asx microscopic: usu renal
gross hematuria: uroepithelial
gross, painless hematuria often 1st manifestation of what?
urothelial tumor
RFs for hematuria?
smoking, analgesic abuse, occupational exposures, medications, recent URI, HTN, pelvic irradiation, FHx of renal dz
if painless hematuria what do you need to assume it is until you rule it out?
tumor of bladder, kidney or prostate
if hematuria at start of urination? if end? if throughout? if cyclically with menstruation (but not vaginal source)? if blood btw voidings?
start: anterior urethral lesion
end: bladder trigone, prostate, bladder neck, posterior urethra
throughout: bladder, ureteral, renal pathology
cyclically: endometriosis of urinary tract
blood btw: bleeding on either end of the urethra
causes of hematuria? (VINDIC[A]TE)
Vascular: hemangioma, AV malformation, renal vein thrombosis, arterial emboli to KD
Inflammatory: UTI, STI, GN, PN, radiation nephritis/cystitis, IC, TB, endocarditis
Neoplasm: prostate, urethra, bladder, ureter, KD, BPH, endometriosis
Drugs: nephrotoxins, aminoglycosides, cyclosporine
Idiopathic: oral contraceptives
Congenital: cystic dz, polycistic KD, solitary renal cyst, benign familial hematuria, Alport syndrome
Trauma: exercise-induced, abd trauma, pelvic fx, iatrogenic (catheterization), foreign body
Endocrine/metabolic: bleeding dyscrasias, hemophilia, Henoch-Scholein purpura, sickle cell animea
DDX hematuria?
dyes, pseudohematuria from dehydration, foods (beets, rhubarb, berries), vaginal source, genital/perineal trauma, drugs
workup for hematuria?
UA, complete microscopy, urine C and S, coag screen, renal fxn tests, PTT, CBC, PSA (when indicated), urine cytology
be sure to consider hx: if UA clear, repeat in 1 week
if hx of trauma or exercise induced then repeat in 24-48 hrs
consider if it actually was a CCMS
complete UA should be done in all high risk groups for CA, previous hx of stones or renal dz
what to do if cause is unclear?
refer to urologist/nephrologist
when palpating the KDs, if tender what can this indicate? if mass? if pitting edema in the area? if abd stystolic bruits hear? is visible mass in child?
tender: infxn
mass: hydronephrosis, tumor or infxn
pitting: perinephritic infxn
systolic bruits: stenosis or aneurysm of renal artery
visible mass in child: Wilm’s tumor
when is it C/I to do DRE?
acute urethral d/c
acute prostatitis
acute prostocystitis
CaP
4 clues to renal abn on general PE?
- gross deformity of external ear in child & ipsilateral maldevelopment of facial bones may have congenital abn of ipsilateral KD
- lateral displacement of the nipples can be assoc. w/BL renal hypoplasia
- renal abn seen w/congenital scoliosis and kyphosis
- general appearance - skin brown, pallor, uremic frost
if urine smells like ammonia? sweet-brown or frothy? fruity-sweet? maple syrup? foul smelling?
ammonia= bacterial sweet-brown or frothy = bile fruity-sweet = ketones maple syrup = MSUD, fenugreek foul = fecal contamination
random SG >1.020 is a good indication of what?
intrinsic KD dz
optimal pH on UA? protein should be? glucose (+) when blood glucose above what? blood? nitrite? leukocyte esterase? ketones? urobilinogen? bilirubin?
pH ~6.5 optimally - acidic in lung dz, DM, diarrhea, dehydration; alkaline in renal failure, proteus infxn, hyperventilation
protein should be (=), dip picks up albumin not globulin! if >3.5 g/d on 24 hr collection then nephrotic syndrome!
glucose should be (=), spills into urine when >170
blood should be (=), dilute urine SG <1.008 will lyse RBCs
nitrites should be (=), can indicate coagulase-splitting bac (E. Coli, enterobacter, pseudomonas)
leukocyte esterase should be (=)
ketones should be (=), could indicate DM, anorexia, dehydration, N/V, fasting, wt loss, EtOH intoxication
urobilinogen should be (=), often first sign of viral hepatitis!!
bilirubin should be (=)
if elevated bilirubin and urobilinogen suspect what?
liver dysfxn
if high bilirubin but neg uro suspect what?
biliary stasis
if high urobilinogen but neg bili suspect what?
hemolytic cause
when do you see RBC casts?
acute GN or vasculitis
when do you see broad, waxy casts?
nephrotic syndrome - renal failure casts
what crystals do you seen in acidic urine? alkaline urine?
acidic: uric acid and calcium oxalate
alkaline: triple phosphate
SG value showed diminished renal fxn?
as approaching 1.010
urine osmolality measures what?
measure of urine concentration
BUN rises when?
first with decreased GFR
influenced by dehydration, dietary protein, GI bleeds, drugs
urine creatinine vs serum creatinine?
urine is stable #
serum can raise w/muscle metabolism, affected by diet, MS mass
BUN:Cr ratio > 20:1 indicates what?
BUN:Cr ratio <10:1 indicates what?
> 20:1 indicates prerenal ARF
<10:1 indicates renal damage leading to decreased reabsorption of BUN and increase in serum Cr = intrinsic ARF
> 3.5 g/d protein collection on 24 hr urine collection?
nephrotic syndrome = GBM damage
cystatin C use?
serum levels will increase as GFR decrease - more sensitive than Cr, less dependent on age, gender, race, ms mass
gold standard for measuring GFR?
inulin infusion
fractional excretion of sodium used to measure what?
predictive of incipient ARF
<1% suggests prerenal ARF
>1% suggests intrarenal ARF
type of anemia seen in CRF?
normochromic normocytic anemia
PSA level that correlates with CaP?
> 4.0
indications for renal bx?
persistent hematuria
nephrotic syndrome to guide tx
rapidly progressing GN
unexplained RF
uroflowmetry measures what? cystometry measures what? pressure flow study measures what? electromyography used to assess what?
uroflowmetry: measures vol voided, time, flow rate, max flow rate
cystometry: measures volume, storage capacity, P in bladder
pressure flow study: measures both urine flow and bladder P
electromyography: can assess pelvic floor or periurethral ms activity for abn contraction/relaxation
